A wonderful organization that does so much to support people struggling with eating disorders is the National Eating Disorders Association. On their website, they have a wonderful page on body image that lists “Ten Steps to Loving Your Body“. If you or anyone you know is struggling with body image or eating concerns, check out NEDA and check out this inspirational page: https://www.nationaleatingdisorders.org/10-steps-positive-body-image. Spread the positive thinking!!! or click on the link: NEDA
Remember back in the day when you had recess in elementary school? It was always the highlight of the day, the time where you could run free outside, swing on the swings, play tag, or climb the monkey bars. Then after school, if you were lucky, you were allowed to play kickball outside with your friends until it got dark. Before you ever thought about being active or needing to exercise to be healthy, you were already doing it. But you were having fun!!
Things have changed. It seems to me there are few adults that I know who do fun active things because, well, they are just FUN. Most adults, especially those with body image or weight concerns appear to be “forcing” themselves to “exercise” with the intention of losing weight and/or changing their body. Not to be stronger, feel better or have more energy. This typically organized movement (aka exercise) sometimes involves a gym, a treadmill, a video or some other activity that the person does not look forward to (not like the monkey bars back in the day). Yes, there are many people who actually really love to going to the gym and actually have a blast doing their Zumba class. These are not the people I am referring to.
In her book “Body Wars: Making Peace with Women’s Bodies”, Dr. Margo Maine explains that particularly if you exercise excessively it could be a symptom of an underlying psychological condition. If you are not able to solve the issue yourself you may need the support of a therapist. She describes the following behaviors that may indicate a problem:
you judge a day as “good” or “bad” based on how much you exercised
you base your self-worth on how much you exercise
you never take a break from exercise no matter how you feel or how inconvenient it is
you exercise even though you are injured
you arrange work or social obligations around exercise
you cancel family or social engagements to exercise
you become angry, anxious or agitated when something interferes with your exercise
you sometimes wish you could stop but are unable to
you know others are worried about how much you exercise but don’t listen to them
you always have to do more (laps, miles, weights) and rarely feel satisfied with what you have done
you count how many calories you burn while exercising
you exercise to compensate from overeating
So, if any of these description ring true for you, just being aware is the first step. For more information on Dr. Maine’s book which includes many great resources for those struggling with body image concerns, check out this link:Body Wars
And remember, it is never too late to start going to the playground again!!!
There are a lot of misconceptions about Health at Every Size®, even among people who know that dieting is futile. I want to talk about them here and why they are just plain wrong.
Misconception #1: HAES® is just an excuse to overeat all the time. Why it’s wrong: You might have missed it, but “health” happens to be the first word in Health at Every Size®. Is constantly overeating healthy? I think most of us can agree it is not. The opposite of restrictive eating is not overeating, it is freedom to eat, which is a very different thing than overeating. In fact, many studies on restrictive eating show a strong association with overeating, which means that you are more likely to frequently binge-eat while on a diet than you are not on a diet at all. HAES® emphasizes getting in tune with internal signals of hunger and fullness…
Today I attended a conference presented by Walden Behavioral Care on the topic of Binge Eating Disorder (BED). Dr. James Greenblatt, Chief Medical Officer at Walden and author of the book “Answers to Appetite Control:New Hope for Binge Eating and Weight Management” spoke about the complicated interactions between our physiology and brain when it comes to binge eating. There are specific criteria that define a diagnosis of BED and just one of the criteria includes “recurrent episodes of binge eating characterized by both of the following: (1) consuming an abnormally large amount of food in a short period of time compared to what others might eat in the same amount of time and under the same or similar circumstances, and (2) experiencing a loss of control over eating during the episode. Additionally, in BED there is “significant distress” about the binge eating.
Dr. Greenblatt stressed that some binge eaters experience cravings that are physiologically based, in other words, the cravings are a result of your biology rather than just the environment or a social trigger. In fact, some research showed that brain scans of those who scored higher on a “food addiction” rating scale were similar to those of drug addicts. There was an elevated activation in the reward circuitry in response to food cues. Again, this does not mean that if you binge eat, you are “addicted” to food, but that everyone is different and some people have the physiology that makes it much harder (and it is not their fault).
In addition, disordered eating such as binge eating often co-exists with mood disorders such as bipolar disorder, anxiety disorders, depression and ADHD . In fact, ADHD has been linked to BED (apparently the act of chewing helps to decrease day dreaming brain waves and helps you pay attention). The odds of developing a binge eating disorder is 12 X greater in children with ADHD. Dr. Greenblatt stressed the importance of treating the mood disorder first before the binge eating could be addressed.
Another very important point was regarding the importance of protein. There are over 250 neurotransmitters that send impulses throughout our brains and affect our thoughts, feelings and behaviors, many of these directly affecting our appetite regulatory mechanisms. They are all derived from amino acids. Adequate protein intake is critical, often an issue for some. For example, vegetarians and vegans may not get enough protein (especially if they are not educated on nutrition) and chronic dieters often have inadequate intakes. And, even if a person does consume adequate protein, it may not always be available, such as in the case of insufficient digestive enzymes or excessive antacid use.
Finally, there was mention of how for a small percentage of people, certain foods substances may contribute to food addiction and binge eating, such as high fructose corn syrup and MSG (he also discussed the gluten craze as well as casein but I may save that for another post!) This does not mean we need to cut out any foods or that we should never eat them, it just is important to have balance in your life.
The importance of medication (such as mood stabilizers) in some cases was also mentioned, as well as how medication was not helpful in other cases. The bottom line is that everyone is different, and it is very important to get evaluated by a professional. BED is a serious and debilitating eating disorder, but there is help.
When I hear a person say “Saturday is my cheat day” I gotta be honest, it pushes my buttons. To most people it sounds like a harmless thing, but to me it is a red flag. An alarm goes off, triggering this irritating feeling throughout my body. I try not to react, it is a conscious decision on my part to ignore it if I am overhearing a conversation in the elevator of the hospital where I work part time, or somewhere else where there really is not time to get into it. Otherwise, such as a party or other informal gathering where women especially tend to chat about what they are doing to change their bodies…. I always take the opportunity to educate people about Health at Every Size, and how focusing on being healthy verses being thin is a much more sane goal. Then I may ask what they mean by”cheat day”. Inevitably, it means following some type of “healthy” eating plan or dieting throughout the week, then allowing themselves to overeat any of the foods they have denied themselves during the week on Friday or Saturday, and often again on Sunday.
What bothers me about this approach to eating is that it ignores all of the principles of “mindful” eating, and about “listening to your body” . It gives food so much more power than it deserves. It makes me think of how back in the day (and actually still today unfortunately) food is used as a reward. For example, “if you finish your spinach, you can have the cookie”. What does that message send? It says “something is very wrong with spinach, and something is very special about cookies”. I wish food was never treated this way. If you are really honest with yourself, you have to admit, that sometimes fresh vegetables or a great salad or roasted garlic with asparagus is extremely yummy. And an Oreo cookie could never substitute for that taste. If however, one were to hold that Oreo up as a reward, then it might be different. Over time,we might become conditioned to look at that sweet in a different way, and want it even if we really didn’t want it! If we really were mindful and not conditioned to think some foods were good and some foods were bad (that we could only eat them on a “cheat” day) and REALLY listened to what our bodies wanted, then we would not even need a “cheat” day. We would eat in a mindful way, cooking meals that were healthy and that we enjoyed, because we want to feel good, have energy and live a long and healthy life. But that means enjoying the fun foods too, the ones that are important to us, in our culture, our family traditions or socially. Having a homemade blueberry muffin at Grandma’s house or sharing a favorite dessert when out with our old college roommate,or Grandma Harmon’s favorite cinnamon buns that you only get once in a blue moon. It may not be a Saturday or a “cheat” day, but it may be and should be just part of normal life. Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday….I hope everyday you listen to your hunger, and fullness, and enjoy healthy eating, have energy, and never miss an opportunity to enjoy a serving of a special food that you enjoy. Heck with “cheat” days. Enjoying life is living, not cheating.
I first encountered the term “Diet Jail” in 1975. I was a biology major at Clark University in Worcester, Mass. I remember clearly working with the lab teacher who was doing his research on birds (he kind of looked like a cool woodpecker). He made me count bird chirps he had taped on a recorder. I decided I did not want to be a biology major because counting bird chirps was incredibly boring. So I met with my adviser who asked me what I was interested in. My best friend Joyce was a vegetarian and ate very interesting things such as yogurt with sunflower seeds and honey, and so I told him, I though vegetarianism was interesting. He told me I should be a dietitian. I did not know what that was, but anyway, I ended up transferring to the University of Connecticut to study nutrition. For my first nutrition class (Nutrition 101) I had to do a report about fad diets and at the time there were many books out there on the market, including the Atkins Diet. But I found one called “The Psychologist’s Eat Anything Diet” by two psychologists, Dr. Pearson and his wife, also Dr. Pearson. It changed my thinking in a way that lasted, well, forever. The authors were decades before their times in the strategies they were promoting, before we knew about mindful eating or how our bodies regulated themselves regarding calorie intake, fat, carbohydrate intake, etc. They described what they called “diet jail” where individuals who diet tend to “lock themselves up” in a jail where only the healthy foods exist. In other words, they tell themselves they are only going to eat healthy foods such as grilled chicken, vegetables, fruits, salad, etc until they lose the weight. So psychologically it is as if they “lock themselves up” in a world where only the healthy foods are available (or allowable). But outside the jail are all the other foods, the “bad” foods. The chips, cookies, ice cream, burgers, pizza, you get the picture. All the foods they have determined they are not allowed to eat (while they are on that diet). And so, most people can last a bit in Diet Jail. Yes, they get cravings, but they use their “willpower” and overcome them. Unfortunately, we now know our bodies send out very loud signals when we are not getting enough carbohydrate or fat (the foods that do not exist in Diet Jail!) and so eventually, our bodies drive our brains to give in. Add this physiological drive to an environmental trigger, such as walking into your friend’s home who just baked some homemade chocolate chip cookies, and things change. Your brain, which is triggered by the deficiency in your body, tells you to eat a cookie! It has just what you need, what you have been missing, that fat and carbohydrate! But you can’t have someone throw just one cookie into your jail cell, so you have to step out of the jail to get that one cookie…….the problem is, once you take that bite, your realize you are out there! Out of Diet Jail! And since you know you will go back in (you tell yourself that on Monday you will really start again!) you better eat while you are out here! So you decide to order pizza, and then have ice cream (a lot) because, heck, you are going to start again on Monday. Often a full blown binge results. Because you know this is just this one time. Soon you will be back on track. Back in Diet Jail. Until the next time.
As repetitive as this cycle is in so many people’s lives, they do not seem to stop. The next diet craze offers the next magic scheme. Weight is lost and then regained. Back then we did not know the physiological reasons people were driven to eat but now we do. We know if you restrict you will suffer from “disinhibition” or breaking out of Diet Jail.Often referred to as the “what the hell” effect. It is a very sad and draining cycle.
So why not take those bars down? Why not entertain the thought of changing what you have been doing that is not working? What if you were to start to believe that all foods are equal? No food is good, no food is bad, they all have a place in your life. Yes, we need certain nutrients to feel good, have energy, normal bowel movements, prevent disease, etc. So educate yourself (I will gladly help you!), experiment, enjoy your cultural traditions (yay. pasta fagioli!) but start paying attention to your body. Are you hungry? Are you full? Are you so confused that you might really want to get some help (such as from an eating disorder specialist?). Wherever you are, it is ok, just take some time to truly reflect on your patterns. My hope for you is to enjoy eating, be healthy, and take down those darn bars.
This women’s face is how I feel several times per week. Have you fallen for the latest weight loss craze? This is driving me crazy!! It angers me when people are taken advantage of because they are desperate to lose weight. How do you define “clean eating”??? And why does it usually involve some type of juice that you need to purchase?? Anyway, try to find some good long term outcome studies on this diet approach, and please share them with me. I can’t find any. The bottom line is any trick to make you eat A LOT less will make the force of gravity on your body less over time (that means you will weigh less). It won’t last. Most of these diets have you do a juice fast or just fruits and vegetables or maybe a “clean” shake for a certain amount of time. You will lose weight as your body breaks down muscle (sorry but the Krebb Cycle prefers amino acids to keep producing it’s ATP’s for energy, not the fat you are hoping it would use). Not to mention the typical dehydration that occurs when your body is breaking down muscle from starvation (because when you break down muscle you need to get rid of the nitrogen through your kidneys, and your body knows to use water to dilute it otherwise your kidneys would be damaged…unfortunately, that happens to some people anyway). And if you are getting way too little calories, your body may be building up toxins in your blood called ketones….that isn’t too “clean” if you ask me.
Not to mention, don’t you have to eventually eat something? Then what? Have you learned anything about yourself? Have you identified some unhealthy habits you may have had and are you magically now able to change them? Probably not. If I could have a dollar for everyone I knew who lost weight on a plan like this, but then gained it back, I might have retired by now. This latest fad is nothing new, just like the low carbohydrate diets, the low fat diets, the high protein diets, and on and on, it just delays the inevitable work your really need to do.
I’m good with vegetables and fruits in your diet. But this is way too much thinking and that is something we know people can’t sustain over time. Why not simply work on adding in these healthy foods to your diet and continue working on listening to your hunger and fullness, recognizing when you are eating when you are not really hungry, taking time to move your body because it is fun and feels good and also contributes to your health? Stop all the “cognitive restraint” and focus on health. There is no such thing as clean eating.
I have a few simple questions to ask before I explain what HAES is:
1. How many people have you known who have “gone on a diet” specifically to lose weight?
2. Have you ever known someone who has gone on a diet and who has lost weight and kept it off? I am not talking about the person who took up a sport or quit smoking and adopted a healthier life style. I am talking about someone who followed a specific “diet plan” such as a low carb diet or meal replacement diet or counting calories or points kind of diet.
3. Have scientists discovered the one diet that works to help people lose weight and keep it off? Of course we know researchers have been looking into this, since people have been struggling with trying to lose weight for a long time. The “obesity epidemic”is always in the news. So have they found the one diet that works?
Not sure of your answer for question #1, but for #2, I am guessing the answer is NO, and for question #3, I will tell you the answer is NO. What most of the public does not know (because who would be interested in the research over the years regarding dieting except someone like a dietitian?) is that many researchers have been looking into dieting behavior for decades. In fact, when I went back to graduate school and did my research on “cognitive restraint” back in the ’90’s, I was angry! I could not believe the world did not know that the “experts” already knew many of the reasons dieting did not work! But then I realized, it is about the diet industry combined with desperate people wanting to lose weight.
I was not the only one who was angry. There now exists a split among health professionals working with people with weight issues (actually, the split has been there for many years but only recently gaining attention). Thanks to the more recent research and new groundbreaking books (see below) by Dr. Linda Bacon, the “Health at Every Size” Movement has now been brought into the public eye and the movement is gaining momentum.. Those of us who believe in promoting health instead of some perfect weight, are no longer alone. Yes, there are still doctors, nurses and dietitians who will put someone on a diet (boy could I tell you some horror stories). So it is important to ask any professional you are working with which side of the fence they are on. Are they familiar with the HAES Approach? If not, they may be a bit behind the times. Or, they may still be influenced by a society who values a certain physical appearance instead of health.
Here is an excerpt taken the HAES website at http://www.haescommunity.org/ :
“Health at Every Size” is based on the simple premise that the best way to improve health is to honor your body. It supports people in adopting health habits for the sake of health and well-being (rather than weight control). Health at Every Size encourages:
Accepting and respecting the natural diversity of body sizes and shapes.
Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.
Finding the joy in moving one’s body and becoming more physically vital.
and from Dr. Linda Bacon: “Health at Every Size is the new peace movement.”
“Very simply, it acknowledges that good health can best be realized independent from considerations of size. It supports people of all sizes in addressing health directly by adopting healthy behaviors.”
Why on earth would a dietitian even question a vegetarian diet when it seems like such a healthy way to eat? Eliminating all that saturated fat in the form of meat from your diet has to be a good thing, right? And when you think of vegetarians, don’t you get a vision of someone munching on a giant salad?
Well, let me give you a reality check. Having been around the block a few times (meaning I have been a dietitian for over 35 years), I have encountered my share of vegetarians. When someone tells me they are a vegetarian, or a vegan, I do not make any assumptions about their diet or their intentions. But what I have found is that the reasons people become vegetarian are not always clear. I have noticed that people turn to a vegetarian diet for a few different reasons. In fact, I have encountered 3 types of vegetarians over my long career as a nutritionist (my experience only, I can’t speak for everyone). The people I have worked with or have known in my life tend to fall into the following categories:
1. The True Vegetarian: This is the individual who truly has a strong empathy for animals. They just are not comfortable with consuming them. They may have had meat in their lives but then, they change and make a decision that they do not want to eat meat any longer. There are different types of vegetarians, those who are ok with eating dairy or eggs or fish, but not meat. I remember my daughter as a teenager getting very upset when the rodeo was in town, and she actually joined a group who stood on the corner and protested. This led her to looking into protecting animals and she decided to stop eating meat at the time. I also have a best friend who is vegetarian, is a great cook, and who also is all about protecting animals (it is a passion with many vegetarians I have come to know over the years). They eat everything, just not meat. I have to say, not all of those I have met who are true vegetarians are healthy eaters like my friend. Many people (especially teenagers who love their kid-foods) tend to live on noodles and chips, still vegetarian, but no vegetables involved!
2. The “I want to be healthier” Vegetarians“: These are the people I have encountered who may have developed some health issues such as high cholesterol, and decided they are going to “cut down on” meat consumption. The reason they want to change their diet is because being healthy is important to them. They may have an occasional meal with meat, but otherwise they believe eating less of it is healthy.
3. The “I am pretending to be vegetarian because it is a good excuse to eat less”Vegetarians: Unfortunately, I have worked with many people over the years with eating disorders who start out with “vegetarianism”. They start eliminating foods, and becoming a vegetarian is kind of a good “excuse” for the eating disorder to NOT EAT. This type of “vegetarian” is different in that they typically refuse to eat the normal vegetarian standbys such as peanut butter, nuts, beans, etc. They may say they do not like salad dressing, olive oil, trail mix, granola or nut butters. This is always a “red flag” to me. Most of the “True Vegetarians” I know rely on nuts and peanut butter for protein and have no problem with pasta and rice and beans and all the other food needed to round out their diets. Not to mention delicious Tofutti Ice Cream!
So what is the bottom line? If you or someone you knows decides to become vegetarian, always ask “why?” If it is to be healthier, or because you care about animals, then you can definitely meet your nutritional needs with some guidance. Vegan diets are a bit harder in that you may need supplemental iron, vitamin B-12 and calcium, and also you need to know how to get protein in your diet (I recommend seeing a Registered Dietitian to be sure-check out http://www.eatright.org and “Find a Dietitian”). But if you know someone who just started being a vegetarian, is losing weight, who no longer eats potato chips (those are vegan!) then don’t ignore it. It could be an eating disorder just beginning.
I was a little concerned when restaurants started to post the calorie content of menu items. I have to admit, I am a bit torn between the importance of educating people about nutrition and my mission to prevent disordered eating and promote a healthy relationship to food. My friends and family often argue with me when I say “listen to your body”. My husband says “my body told me to eat the whole thing!”.
What my husband is referring to is most likely the “trigger” that yummy food is to most of us (and not true hunger, something not very easy to tune in to for many). We are all different in the way we respond to food and eating, and not everyone is able to “listen to your body” because they have a unique eating, weight, dieting, genetic history that no one can understand except themselves. So what does counting calories have to do with anything? Why would I have any concerns with labeling calories on menu items? Should you count calories to have a healthy weight?
My answer: The Top 5 Reasons you should not count calories:
1. It is hard enough to work on the task of paying attention to your hunger and fullness, so when you attach a number to a meal or snack, you are almost guaranteed to become “disconnected” to your true body signals. Imagine you have determined you need a certain amount of calories for the day, and by evening you feel full after your last meal and do not want that pm snack you are supposed to have. Should you force yourself to eat it? or what if the opposite happens and after your dinner with the specified calories, you are still hungry? Do you forbid yourself a snack and think about food all night long? What if you made a mistake, which leads me to reason number 2.
2. You will not be accurate! The calories posted on many packages and menus may not be accurate! Check out this interesting video about a small experiment in NYC regarding this topic. WARNING: this video only looked at a few foods and most had more calories than stated on the package or menu. The reverse is also likely, where menu items have less than stated. The message is, nobody is held responsible for accuracy! If you are obsessive already about eating and calories, this video may be triggering and you should skip it.
3. It encourages obsessive thinking about food which can backfire. When you use “cognitive restraint” such as counting calories, you become MORE focused on food, not less. Research shows that people who are overly restrictive tend to be more likely to binge eat. Even worse, this behavior is more likely to lead to disordered eating patterns.
4. Counting Calories does not translate into healthy eating. As I said earlier, although I believe in “listening to your body” I also believe it is good to want to be healthy. That may mean learning about nutrition, healthy cooking, what your body needs to feel good, etc. If you only look at calories, you are missing the boat.
And Finally,
5. Counting Calories is not fun and really interferes with your social life! Not only is it harder to go out to eat once in awhile with friends, even family celebrations become a chore instead of something that should be enjoyed as one of the most wonderful parts of life. Not only that, people who are restrained eaters (such as calorie counters) tend to be more depressed.
So the bottom line is: it is ok to educate yourself about nutrition, but calorie counting is not a great thing. You can’t avoid seeing the calorie count on the menus, and if you get indigestion every time you get that certain giant burger, well, seeing the calories may help you understand why….but your tummy will tell you that, you really didn’t need to know the number after all : )
Joanne Arena MS, RD 